The North American Spine Society (Burr Ridge, IL) describes fusion as a surgical technique in which one or more of the vertebrae of the spine are united together (fused) so that motion no longer occurs between them, thereby decreasing the pain at that segment. The concept of fusion is similar to that of industrial welding. However, spinal fusion surgery does not weld the vertebrae. The procedure uses bone grafts, with or without screws, plates, cages, or other devices. The bone grafts are placed around the problem area of the spine during surgery. As the body heals itself, the graft helps join the bones together.
Fusion does provide pain relief for many patients, but the procedure is not always successful. Back pain sometimes returns, and more than half of patients develop sciatica, a gnawing pain that runs from the lower back down the back of each leg.
While fusion currently remains the dominant surgical procedure for back pain, over time it is expected to gradually cede ground to less-invasive procedures and alternative movement preservation technologies, including disk arthroplasty (artificial disk replacement), bone graft substitutes, nucleus replacement, interspinous process spacers, posterior dynamic stabilization devices, percutaneous injection procedures (vertebroplasty and kyphoplasty), image-guided surgery, and others.
"While spinal fusion will always have a place, its share of the treatment market is expected to decline," says Patrick Driscoll, president of MedMarket Diligence (Foothill Ranch, CA). "Newer treatments such as total disk replacement and nuclear arthroplasty will erode the spinal fusion market, as these and other treatments which preserve spinal motion gain favor over the invasive and traumatic fusion of two or more spine segments."
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